NHS Gloucestershire CCG
Male breast reduction for gynaecomastia
|Commissioning decision |The CCG will provide funding for male breast reductions for gynaecomastia for patients who meet the |
| |criteria defined within this policy. Funding approval for eligible patients must be sought from the CCG |
| |via the Prior Approval process prior to treatment. |
Policy Statement:
|Surgery will be funded for gynaecomastia (growth of glandular tissue in male breast) where: |
|The reduction in breast tissue will be significant (i.e. 250g or more), with Simon Grade 3 or more (see evidence section) |
|OR |
|There is gross asymmetry |
| |
|In addition the patient must: |
|Be post-pubertal |
|AND |
|Be ≥ 18 years of age and the condition persistent for 2 years |
|AND |
|Have a BMI of ≤ 25 |
|AND |
|Have been investigated for possible endocrinological and/or drug related causes (see evidence section) |
Rationale:
|Most cases of gynaecomastia are idiopathic. It can also occur during puberty, when it tends to resolve as the post-pubertal fat |
|distribution is complete. It can also occur secondary to medication such as oestrogens, gonadotrophins, digoxin, spironolactone and |
|cimetidine, as well as anabolic steroids. |
| |
|Rarely it may be caused by an underlying endocrine abnormality or a drug related cause including the abuse of anabolic steroids. It is |
|important that male breast cancer is not mistaken for gynaecomastia and, if there is any doubt, an urgent consultation with an |
|appropriate specialist should be obtained. |
Plain English Summary:
|Gynaecomastia is a common condition that causes boy’s and men’s breasts to swell and become larger than normal. It is most common in |
|teenage boys and older men. Signs vary from a small amount of extra tissue around the nipples to more prominent breasts. It can affect |
|one or both breasts. Sometimes, the breast tissue can be tender or painful, but this isn’t always the case. |
|Gynaecomastia can be caused by an imbalance between the sex hormones testosterone and oestrogen. Oestrogen causes breast tissue to grow. |
|While all men produce some oestrogen, they usually have much higher levels of testosterone, which stops the oestrogen from causing breast|
|tissue to grow. If the balance of hormones in his body changes, this can cause a man’s breasts to grow. Sometimes, the cause of this |
|imbalance is unknown. The growth in breast tissue is not due to extra body fat from being overweight, so losing weight or doing more |
|exercise will not improve the condition. |
|In rare cases, gynaecomastia can be caused by: |
|side effects of medication, such as anti-ulcer drugs or medication for heart disease |
|illegal drugs, such as cannabis or anabolic steroids |
|drinking too much alcohol |
|a health abnormality, such as kidney failure or liver disease |
|Klinefelter’s syndrome, a rare genetic disorder |
|lumps or infection in the testicles |
| |
|There are two types of treatment for gynaecomastia: |
|surgery to remove the excess breast tissue |
|medication to adjust a hormone imbalance |
|Procedures such as breast reduction surgery are not usually available on the NHS unless there is a clear medical need. If your doctor |
|believes that you meet the criteria set out in this policy they can submit a Prior Approval application to the CCG in order to seek |
|funding approval for your surgery. The CCG will review your case and if we agree that the criteria have been met we will authorise |
|funding. |
Evidence base:
|Lanitis S, Starren E, Read J, Heymann T, Tekkis P, Hadjiminas DJ, Al Mufti R |
|Surgical management of Gynaecomastia: outcomes from our experience |
| |
|Gynaecomastia – Practice Clinical Updates |
| |
| |
|Diagnosis and assessment and drug related causes patient.co.uk/doctor/gynaecomastia |
| |
|Gynaecomastia classification and treatment options – evidence basis |
| |
| |
|Prostate Cancer - dealing with the side effects of treatment – enlarged breasts. |
| |
| |
|Simon et al. (Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia Plast Reconstr Surg . 1973;51:48) |
|divided gynecomastia into four grades as follows: |
|• Grade 1: Small enlargement, no skin excess |
|• Grade 2a: Moderate enlargement, no skin excess |
|• Grade 2b: Moderate enlargement with extra skin |
|• Grade 3: Marked enlargement with extra skin |
Link to application form – Prior Approval Application Form
For further information please contact GLCCG.IFR@
|Date of publication |1st August 2015 (Minor amendment 7th February 2017) |
|Policy review date |November 2023 |
Consultation
|Consultee |Date |
|Planned Care Programme Board |31st March 2015 (virtual) |
|CCG Governing Body Development Session |4th June 2015 |
|GHNHSFT (via General Manager/Head of Contracts) |18/05/2015 – 29/05/2015 |
|GP Membership (via CCG Live/What’s New This Week) |06/05/2015 – 05/06/2015 |
| | |
|Has the consultation included patient representatives? |No |
Policy sign off
|Reviewing Body |Date of review |
|Effective Clinical Commissioning Policy Group |8th November 2016 |
|Integrated Governance and Quality Committee |18th June 2015 |
Version Control
|Version No |Type of Change |Date |Description of Change |
|1 | |1.8.15 | |
|2 |Date & link added |18.10.18 |Review date changed to Nov 2023. Link to Prostate |
| | | |Cancer (dealing with side effects of treatment) added|
| | | | |
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Policy Category:
CBA&PA
Who usually applies for funding?
GP/Consultant
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